October is National Breast Cancer Awareness Month. Breast cancer is the second most common cancer among women (skin cancer is the most common), and it is the second leading cause of cancer death in women after lung cancer. The sobering statistics:
About 211,240 women in the United States will be diagnosed with invasive breast cancer in 2005.
About 40,410 women will die from the disease this year. Right now there are slightly over 2 million women living in the United States who have been treated for breast cancer.
The chance of a woman having invasive breast cancer some time during her life is about 1 in 7.
The chance of dying from breast cancer is about 1 in 33.
That summarizes the situation with regard to the general population, but what about among transplant recipients? Kasiske and colleagues examined malignancy among 35,765 first-time recipients of deceased or living donor kidney transplants in 1995-2001 using Medicare billing claims. The rate of breast cancer was found to be roughly 2-fold higher in kidney transplant recipients compared with the general population. Historically, transplant recipients have not been considered at increased risk for breast cancer. However, similar to other tumors observed in the transplant population, breast tumors often present at an earlier age and with more aggressive tumor biology than in the general population. In addition, a higher percentage of males with breast tumors have been identified in the transplant population than in the general population.
The good news is that, in general, breast cancer death rates are declining, probably as a result of earlier detection and improved treatment. Therefore, as in the general population, breast cancer should be a major focus of disease prevention in kidney transplantation. The American Cancer Society recommends the following guidelines for finding breast cancer early in women without symptoms:
Mammogram: Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.
Clinical breast exam (CBE): Women in their 20s and 30s should have a CBE as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a CBE by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram.
Breast awareness and breast self exam (BSE): BSE is an option for women starting in their 20s. Patients who perform BSE should have their doctor or nurse check their method to make sure they are doing it right.
Warning signs: Women should see a doctor right away if they notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk.
Women at high risk: Women at high risk for breast cancer should talk with their doctor about the best approach for them. Regular mammograms may need to be started at a younger age or may need to be more frequent.
In an Expert Interview, Joseph F. Buell, MD, of the Israel Penn International Transplant Tumor Registry at the University of Cincinnati in Cincinnati, Ohio, when asked, "What is your opinion about screening for breast cancer in this population?," told Medscape that "Clinical breast exam is a solid intervention, and what is even more critical is a routine mammogram." Seventy-two percent of respondents to a Medscape poll said they referred their female transplant recipients to a gynecologist as part of the routine posttransplant follow-up, but 27% said they did not. The challenge to the transplant community is to increase the referral rate to 100%.
If you have comments or questions about the site, please contact me at slsmith@medscape.net .